Laparoscopic versus robotic-assisted Heller myotomy for the treatment of achalasia: A systematic review with meta-analysis

Background: Robotic-assisted laparoscopic Heller myotomy has been proposed as an alternative minimally invasive approach to traditional laparoscopy for the treatment of achalasia. This systematic review aims to compare the safety and post-operative outcomes of the two procedures. Methods: Systematic literature search was performed in MEDLINE through Ovid, Scopus and Cochrane to identify clinical trials and retrospective analyses. Outcome measures used for meta-analysis included operative time, estimated blood loss, length of stay, 30-day readmission, intraoperative oesophageal perforation, conversion, mortality, morbidity, symptom relief beyond 1 year, re-intervention for recurrent symptoms and gastroesophageal reflux during follow-up rates. Results: Seven studies were selected with a total of 3214 patients. The only factor to be statistically different is intraoperative oesophageal perforation rate, which is lower in robotic-assisted Heller myotomy compared to laparoscopic (odds ratio = 0.1139; 95% confidence interval [0.0334, 0.3887]; p = 0.0005). Conclusions: The results suggest a robotic approach is associated with improved patient safety.